Human Uterus Transplantation from Living and Deceased Donors: The Interim Results of the First 10 Cases of the Czech Trial.

Jiri Fronek,Libor Janousek,Jaroslav Chlupac,Jakub Kristek,Michael Olausson

doi:10.3390/jcm10040586

Abstract

Introduction: Uterus transplantation (UTx) is a rapidly evolving treatment of uterine-factor infertility. We report the results of the first 10 UTx procedures performed at our institution. Methods: The program started in April 2016 as a two-arm study comparing the efficacy of UTx from live donors (LD) and deceased donors (DD). Results: Between April 2016 and April 2018, we performed five DD UTx and five LD UTx. Two grafts had to be removed early due to thrombosis. One graft was removed due to chronic rejection and previous herpes simplex infection at month 7. Graft survival is 70% at one year. Recipient survival is 100% at two years. Live donor survival is 100% at three years. Three live-births have been achieved, two from a LD and one from a graft from a nulliparous DD. Vaginal anastomotic stenosis occurred in 63% (5/8) of grafts. Self-expanding stents have shown preliminary suitability for the treatment of vaginal stenosis. Three recipients developed severe acute rejection. Conclusion: The interim results of our study demonstrate mid-term viability in 70% of grafts. The LD UTx produced two live births and the DD UTx produced one live birth. Nulliparous donors should be considered for donation.

Highlights

Uterus transplantation (UTx) has evolved from a purely experimental to a single method of treatment for women affected with absolute uterine-factor infertility (AUFI) [1,2,3]
Due to the risk of morbidity along with ethical issues associated with the procurement of a graft from a living donor (LD) [6], it is vitally important to establish the potential of grafts procured from deceased donors (DD)
The interim results of our study demonstrate mid-term viability for 70% of uterine grafts

Summary

Introduction

Uterus transplantation (UTx) has evolved from a purely experimental to a single method of treatment for women affected with absolute uterine-factor infertility (AUFI) [1,2,3]. The method soon demonstrated its feasibility [4,5] and has rapidly spread to multiple transplant centers over the world. Despite the procedure becoming more common, many aspects of it remain unclear due to its complexity and overall limited amount of experience. Technical, and ethical issues need to be clarified. Due to the risk of morbidity along with ethical issues associated with the procurement of a graft from a living donor (LD) [6], it is vitally important to establish the potential of grafts procured from deceased donors (DD).

Objectives

Methods

Results

Discussion

Conclusion